Summary

Dealing with friends and family members involves a lot of variables for a treating doctor, so each request needs to be considered on a case-by-case basis. One should help friends and family members get the care they need, but refrain from  providing it themselves. Having said that a blanket prohibition against a physician ever treating a family member, including at home, on vacation, or in a medical setting is unrealistic, impractical, and improbable to occur.

Just about every doctor—99%, according to one survey—receives requests from friends and family for medical advice, diagnoses, or treatment. More than 80% of physicians reported providing at least some type of care (including writing prescriptions). Of those who were asked for advice, 57% said they “almost always” provide it to family members. So, what do you do—or what should you do—when a friend or relative asks you for medical advice or help?

 

1. Follow the rules

Dealing with friends and family members involves a lot of variables, so each request should be considered on a case-by-case basis, right? And each doctor has their own level of comfort and expertise, so each doctor should come up with their own way of handling such requests, right?

No, that’s not right, noted Joel M. Geiderman, MD, FACEP, professor and co-chairman of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.

“Individual rules aren’t a good idea at all,” he explained in an interview with MDLinx.

Dr. Geiderman is the lead author of a recently published article in the American Journal of Emergency Medicine that directly addresses the ethical and practical considerations of medical requests from friends and family, particularly from the emergency medicine perspective.

Physicians don’t have to come up with their own individual rules, Dr. Geiderman said, because many (although not all) national and state associations have policies on this, including the American Medical Association (AMA), the American College of Physicians (ACP), and the American Academy of Pediatrics (AAP).

“The AMA policy on the subject is a good place to start,” Dr. Geiderman recommended.

The AMA policy states: “In general, physicians should not treat themselves or members of their own families.” The AMA policy doesn’t specifically include “friends,” but it’s clear that treating friends poses many of the same questions as treating family members.

The policy goes on to state: “However, it may be acceptable to do so in limited circumstances: (a) In emergency settings or isolated settings where there is no other qualified physician available. In such situations, physicians should not hesitate to treat themselves or family members until another physician becomes available. (b) For short-term, minor problems.”

Even with this policy, physicians may need more guidance for making exceptions under these “limited circumstances.”

2. Allow some exceptions

Such policies are rooted in the Hippocratic concept of “do no harm” (non-maleficence). What’s the harm in treating a friend or family member? For one, the personal relationship can affect the physician’s objectivity, potentially causing harm to the patient from undertreatment or overtreatment.

In addition, a bad outcome would not only hurt the patient but can psychologically harm the physician, as well as damage the personal relationship. For these reasons (among others), physicians are warned against treating friends and family members.

Yet, it’s unreasonable—and possibly unethical—to refuse to provide medical assistance in every situation.

“Physicians also have a positive duty of beneficence to render care in an emergency to the best of their ability until a more trained person (which could be a paramedic) is available,” Dr. Geiderman said. “In parts of Europe, if a person is drowning, it is illegal to not try to assist them.”

He added that emergency medicine physicians, because of their training, have a much broader duty to provide urgent care. But all physicians are called upon at some point to make the occasional exception and provide informal care.

“If a 5-year-old child complains of an earache to mommy-doctor in the middle of the night, who could fault her for examining the ear with an otoscope; or assessing for abnormal breath sounds, fever, clamminess, or meningismus? The same thing could be said for examining a wound or a rash,” Dr. Geiderman and coauthors wrote in their article. “Therefore, a blanket prohibition against a physician ever treating a family member, including at home, on vacation, or in a medical setting is unrealistic, impractical, and improbable to occur.”

This can also include neighbors and friends who have similar questions or requests.

3. Don’t be afraid to say no

When in doubt, just say no. (Actually, don’t just say “no.” Help friends and family members get the care they need, but don’t provide it yourself.)

“If there is any doubt and there is moderate to high risk of a bad outcome, punt it to the ED [emergency department]. The ED doctor will be objective and have diagnostic tools and consultants at their disposal,” Dr. Geiderman said. “If you are working in the ED, have a colleague see the patient.”

Ask yourself if the request meets the definition of an exception: Is the request an emergency, or are you the only qualified physician available? And, is it in regard to a short-term, minor problem?

“I have had friends ask me to prescribe a sleeping pill before they travel or to order a routine prescription refill or ask for advice beyond my expertise. I have no problem saying I can’t do it,” Dr. Geiderman explains. “It is not an emergency and not in their interests.”

But what if you do have a problem simply saying, “I can’t do it”? An article in the Journal of General Internal Medicine by bioethics professor Gregory L. Eastwood, MD, Center for Bioethics and Humanities, State University of New York Upstate Medical University, Syracuse, NY, offers some ready responses:

• “I am happy to help but please understand that [I have not examined you], [I am not a cardiologist], [I am not your doctor].”
   
• “I am not your doctor, but in situations like this I believe X is recommended.”
   
• “I am sorry, but I don’t think I can do this because…”
   
• “Under these circumstances, you should not rely on me for medical advice.”
   
• “I would feel better if you asked your doctor about this.”
   
• “I am your friend (or cousin, etc) who happens to be a physician, but I think you can appreciate that that is different from being your physician.”

If you’re still in doubt, ask yourself that old familiar physician’s question: If it was your mother (son, daughter, etc), how would you want them to be treated?

 

This story is contributed by John Murphy and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.